VIDEO-ASSISTED THORACOSCOPIC SURGERY (VATS) IN CHILDREN

7/29/2019 VIDEO-ASSISTED THORACOSCOPIC SURGERY (VATS) IN CHILDREN

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VIDEO-ASSISTED

THORACOSCOPICSURGERY

(VATS)IN CHILDRENO.Brankov, H.Shivachev, R.Drebov,M.Panov, N.Gavrilova

Department of pediatric surgery

University Hospital Pirogov Sofia, Bulgaria


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Clinical material

PERIOD - may 2003 mart 2005

77 children

Age - 10 m - 18 y 57 children with empyema

17 children with spontaneous

pneumothorax 3 children with mediastinal masses


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SPONTANEUS

PNEUMOTHORAX (n = 17)

age 13 - 18 y

16 boys : 1 girl 9 children (52,9%) with 11 VATS

procedures

8 children with percutaneous drainage pig-tail


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Right sided pneumothorax- 1 pt

Leftsided pn - 6 pt

Bilateral pneumothorax - 2

Initial incident - 3

Recidives:

one - 2 two - 3

three and more - 1

SPONTANEUS PNEUMOTHORAX


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According to the classification ofVandershueren RGJRA (1990)

gr(without any changes) - 0

gr (fibrous dystrophic changes) - 2

gr (multiple blebs) 0

V gr (single bullaes, blebs oradhesions ) - 7


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Classification

Tamura M et al ( 2003)

- small single bleb - 1

- multiples large bulla - combination of dispersed bulla 6

Dystrophic changes are excluded


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Surgical tactic

Diffuse dystrophic changes

purse-string suture with Endo-stitch Polisorb3/0, partial apical pleurectomy and fibrin-

glue adhesion (Tissucol) Single or multiple blebs excision and

suture with Endo-stitch Polisorb 3/0,

pleural abrasion and fibrin glue adhesion


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Suture of the blebs n = 7


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Pleural abrasion n = 7


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Apical pleurectomy n = 2


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Fibrin glue insufflation


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Results

Operative time:

Unilateral VATS - 35 - 55 min

Bilateral VATS- 85 - 115 min

Average pleural drainage time - 3,2 days

(3 5)

Average hospital stay 5,4 days(5 - 7)


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Results

Follow-up 5 - 22 months

Without recurrence - 8

Recurrent pneumothorax after 8 months

N = 1Thoracotomy, apical resection, partial

pleurectomy


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Thoracic empyema

Frequency in children - 0,4-6 1000

(Grewal H et al,1999)

2 - 5 % parapneumonic complications

40 50 % of all empyemas are

consequence of complicated bacterialpneumonia

(Oak S et al,2003)


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The parapneumonic pleural complication isdivided on three stages that are not sharplydistinct but gradually one phase merges intoanother

Exudative stage ( 1 - 3 days) Exudate pH> 7,3, Gl > 60mg/dl, LDH


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57 children

17 with VATS and 40 with conventional

thoracotomy age 10 months - 17 years

0 - 1 3,5%

1 - 7

59,6% 7 - 17 36,9%

32 boys : 25 girls

Clinical material


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Term of admission after onset ofdisease - treatment approach

Up to 10 day (26 pts) transcutaneouspig-tail or tube thoracostmy 100 %

From 10 to 20 day (20 pts) 60 % tubethoracostomy and 70 % VATS (primary40 % ; secondary 30 %)

After the 20 day (13 pts) 30 % primaryVATS; 70 % thoracotomy)


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Indication for VATS

All cases of II and IIIdegree

Multiloculated

effusion Ineffective pleural

drainage

Separated empyema


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Relative contraindication: fibrothorax, requiringopen thoracotomy


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DEBRIDEMENT, SANATIO 15 children


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DECORTICATION- 2 children


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pig- tail

1933,3%

tube drainage

1628,1%

VATS

1729,8%

Thoracotomy

58,8%

Redo tube drainage 3 5

Average drainagetime

7 10,9 5,4

Secondarythoracotomy

5(31,2%)

4(23,5%)

Redo thoracotomy 1 (6,2%)Average drainage

time 16 3,8 10,4Average hospital

stay14,8 27 10,5 17,4


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Biopsy of mediastinal masses

Operating time 35 min

Duration of the drainage 24 h

Hospital stay 3 days

100% confirmed diagnosis

(Comparatively thepercutaneous needle biopsy hasonly 28% diagnosticsignificance)


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ADVANTAGES OF VATS

Less traumatic method

Exact diagnosis

Decreased postoperative complications Low duration of drainage

Comfortable postoperative period

Early rehabilitation Shorter hospital stay

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VIDEO-ASSISTED THORACOSCOPIC SURGERY (VATS) IN CHILDREN